NPI | 1093882870 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CO 8670) |
Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: IA 08045) |
Enumeration Date | 2006-11-29 |
Last Update Date | 2007-07-08 |